Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical School, San Francisco, California.
Am J Prev Med. 2024 Oct;67(4):558-567. doi: 10.1016/j.amepre.2024.06.009. Epub 2024 Jun 12.
Tramadol has been associated with chronic opioid use and emergency room (ER) visits. However, little is known about trends in prescription tramadol use in the U.S.
Optum's de-identified Clinformatics® Data Mart Database was used to assess trends in monthly incident and prevalent tramadol use from 2005 to 2021, stratified by sex and age (18-64 vs. ≥65 years). State-specific trends following scheduling of tramadol as Class IV controlled substance in August 2014 were analyzed with random effects regression models. Demographics, comorbidities, initiation setting, dose, and co-dispensing with other opioids and central nervous system (CNS) agents were assessed in people initiating tramadol, stratified by age and initiation year (2005-2010, 2011-2015, 2016-2021). Analyses were performed in 2023 and 2024.
During 2005-2021, the mean percentage using tramadol in a given month was 0.88% of younger females, 0.55% of younger males, 1.97% of older females, and 1.14% of older males; 5,729,652 initiations were identified. Since 2014, estimated relative yearly decrease was 4% (95% CI 3%; 5%) in use and 5% (95% CI 4%; 5%) in initiation, with variation across states. Primary care percentage of tramadol initiations declined from 49.2% in 2005-2010 to 37.2% in 2016-2021. During 2016-2021, co-dispensing with other CNS agents occurred in 37.8% of younger and 32.1% of older adults initiating tramadol.
Tramadol use was higher in females and older adults, exhibited heterogeneous trends across states, and shifted from primary care to ER and specialist settings over time. Co-dispensing with other CNS agents was common and warrants further monitoring.
曲马多与慢性阿片类药物使用和急诊室（ER）就诊有关。然而，关于美国处方曲马多使用的趋势知之甚少。
使用 Optum 的去识别 Clinformatics® Data Mart 数据库评估 2005 年至 2021 年每月新发病例和流行曲马多使用趋势，按性别和年龄（18-64 岁与≥65 岁）分层。分析 2014 年 8 月将曲马多列为第四类受控物质后各州的趋势，采用随机效应回归模型。评估在开始使用曲马多的人群中的人口统计学、合并症、起始设置、剂量以及与其他阿片类药物和中枢神经系统（CNS）药物的共同配药情况，按年龄和起始年份（2005-2010 年、2011-2015 年、2016-2021 年）分层。分析于 2023 年和 2024 年进行。
2005 年至 2021 年期间，在给定月份使用曲马多的平均百分比为年轻女性的 0.88%、年轻男性的 0.55%、老年女性的 1.97%和老年男性的 1.14%；共确定了 5729652 例起始病例。自 2014 年以来，估计每年的使用率下降了 4%（95%CI 3%；5%），起始率下降了 5%（95%CI 4%；5%），各州之间存在差异。曲马多起始患者中初级保健的比例从 2005-2010 年的 49.2%下降到 2016-2021 年的 37.2%。2016-2021 年期间，在开始使用曲马多的年轻成年人中，有 37.8%和老年成年人中有 32.1%与其他 CNS 药物共同配药。
曲马多的使用在女性和老年人中更高，各州的趋势存在异质性，并且随着时间的推移从初级保健转向 ER 和专科治疗。与其他 CNS 药物共同配药很常见，需要进一步监测。
